Employment Application Step 1 of 5 20% The Meadows is an equal opportunity employer and does not discriminate against applicants or employees on the basis of sex, race, color, religion, sexual orientation, national origin, ancestry or age. In addition, The Meadows does not discriminate against qualified individuals with disabilities. For your convenience, you may upload a resume and optional cover letter below. To be considered for employment, we encourage you to read through our application and fill in those areas not directly addressed in your resume, including specifying the job you are applying for, availability, background check information, and your signature at the conclusion of the application.ResumeAccepted file types: pdf, doc, docx, Max. file size: 32 MB.Upload a PDF or Word Document up to 10MB.Cover LetterAccepted file types: pdf, doc, docx, Max. file size: 32 MB.Upload a PDF or Word Document up to 10MB.PersonalName First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Home PhoneCell PhoneOther PhoneLast 4 Digits of SSN# Date of Birth Month Day Year Place of Birth City, StatePosition Applied For: Full Time Part TIme Shift Availability Days Evenings Nights Date available to start: MM slash DD slash YYYY Are you over 16 years of age? Yes No Have you ever been convicted of a misdemeanor or a felony? Yes No If yes, please explain:Have you applied to work with us before? Yes No If yes, when? Are you willing to work overtime, on different shifts, or on weekends when necessary? Yes No If no, please explain:Do you have access to adequate transportation to travel to and from work in all weather conditions? Yes No The Meadows has a strict attendance policy. Will you be able to abide by a strict attendance policy? Yes No EducationHigh School Name Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Number of years completed: Did you graduate? Yes No College Name Number of years completed Did you graduate? Yes No Major Other Education (Please Specify) Employment HistoryMost recent employment firstEmployer #1 Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Supervisor Position Held Your Duties Reason for Leaving Employer #2 Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Supervisor Position Held Your Duties Reason for Leaving Employer #3 Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Supervisor Position Held Your Duties Reason for Leaving Have you been employed at any of the local hospitals, nursing facilities and/or residential care homes? Yes No If yes, where? ReferencesProfessional Reference #1 (supervisor, co-worker, teacher, etc.) First Last Relationship PhoneProfessional Reference #2 (supervisor, co-worker, teacher, etc.) First Last Relationship PhonePersonal Reference First Last Relationship PhoneUS Military ServiceBranch Highest Rank Received Dates of Service DutiesIn Case of EmergencyPlease notify:Name First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneRelationship Name First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneRelationship Other Experiences or QualificationsWho referred you to The Meadows? Newspaper advertising Indeed Craigslist LinkedIn Family member or friend Internet search led you to The Meadows website Employment agency State employment office College placement service Walk in Certification and Authorization(please read)I certify that all facts contained in this application are true and complete, and acknowledge that The Meadows is relying on the accuracy of the information provided. I authorize The Meadows to verify the accuracy of the information provided herein, and I authorize former employers, educational institutions and credit agencies to release information concerning me to The Meadows. I also authorize The Meadows to give references and provide information about me in response to inquiries subsequent to my employment if hired. I understand that falsification, misrepresentation or omission of requested facts may result in the denial of employment or, if employed, result in immediate dismissal. I understand that, if hired, my employment is “at-will.” I also understand and agree that no one has the authority to promise me job security or continued employment except the CEO of the company in a formal written agreement signed by both of us. In addition, I am giving The Meadows at East Mountain my permission to run a detailed background check on me, including but not limited to: adult abuse, child abuse, fraud and criminal. I recognize that this consent does not constitute an offer of employment, but is a preliminary step in the screening process. An offer of employment is contingent upon no findings in the adult abuse and child abuse checks; I understand the said offer will be revoked due to VT State regulations governing residential care communities. I further understand that I have the right to review and challenge any negative information that would adversely impact a decision to offer employment. Also, I will have a reasonable opportunity to clear up any mistaken information reported within a reasonable time frame established within the sole discretion of the company. Under the Fair Credit Reporting Act, I have been advised that upon request I will be provided the name, address, and telephone number of the reporting agency, as well as the nature, substance and source of all information. Please check the box below to acknowledge acceptance: I understand I may lose my job if any background check comes back with a finding. SignaturePlease note: If you are called for an interview, please bring your driver’s license with you.CAPTCHAEmailThis field is for validation purposes and should be left unchanged. Δ
